Fast Facts Maternal Mortality in the United States Maternal Mortality in African Americans Prenatal Care Women in Abusive Situations Barriers Associated with Receiving Prenatal Care Infant Mortality Rates by Race and Ethnicity Rural Health Care References   Fast Facts The lowest  African American maternal mortality ratio (MMR) reported for African American women equals approximately the highest MMR reported for white women. (1) African American infants are two to three times more likely to be born with a low birthweight and to die during the first months of life.(2) Nationwide, family practitioners provide two-thirds of all obstetrical care in rural areas. (3) Ethnic minority women are two to three times more likely to seek prenatal care late in pregnancy or not at all, and fewer African American women begin care in the first trimester compared than white women.(4)     Maternal Mortality in the U.S. United States has not reached an irreducible minimum in maternal mortality. In 1998, the Healthy People 2000 goal of 3.3 maternal deaths per 100,000 live births had only  been achieved in three states for white women (Massachusetts, Nebraska, and Washington) and eight other states are close to achieving the goal for white women with MMRs of less than 4 per 100,000 live births. (1)   Maternal Mortality in African Americans The four-fold increase in risk of maternal death among black women compared with white women in the U.S. is one of the largest racial disparities among the public health indicators. A black woman's risk of dying due to childbirth is higher for every specific cause of death reported including all the most frequent causes: hemorrhage, embolism, and pregnancy-induced hypertension. The risk is higher for black women of every age group but increases from a two-fold increase among black women in younger age groups to a six-fold increase among black women older than 40. (1) Back to Top  Prenatal Care In 2002, approximately 83.7 % of pregnant women had received prenatal care starting in their first trimester.(5)  The percentage of white women receiving prenatal care during their first trimester was higher than the percentage of minorities:  85.4% of pregnant white women received first trimester care versus 75.2% African Americans, 69.8% American Indian/Alaskan Native, 84.8% Asian American, and 76.7% of Hispanics.(5) The last time the percentage of white women receiving prenatal care was 75% or below was before 1975.(5)       Food for thought.. Women in abusive situations Unintentional pregnancy, substance abuse, inadequate prenatal care, reduced or low birth weight, preterm labor, and fetal and maternal death are among the pregnancy complications and outcomes more common among battered women than among other women.(6) (For more information on this topic, see Domestic Violence) Structural barriers associated with inadequate prenatal care use include:(7) financial barriers inadequate prenatal care system capacity problems within the organization practices and atmosphere of prenatal services lack of transportation loss of wages   Demographic characteristics of women who receive inadequate prenatal care include: (7) low income younger than 20 years old unmarried African American Hispanic first-generation immigrant less than 12 years of education.   Back to Top Infant Mortality by Race and Ethnicity Rates of infant mortality and preterm birth among African Americans in the United States are approximately twice those for white infants.(4) African American infants in the United States die at twice the rate as white infants and are two to three times more likely to be low birth weight than white infants. (4) In 2002, there were 5.8 infant deaths per 1000 live births for Whites, 13.8 deaths for African Americans, 8.6 for American Indian/Alaskan Natives, 4.8 for Asians, and 5.6 for Hispanics.(5) Higher rates of low birth weight infants among African American infants in the United States appear to be related to the higher incidence of preexisting and pregnancy-related medical conditions in African American women, as well as low rates of prenatal care particularly those who are low income.(4) These conditions include infections and preexisting conditions such as sickle cell anemia, chronic hypertension, and heart disease.(4) Rural Health Care Rural families are less likely than urban families to obtain insurance or to have it provided by an employer, and Medicaid and medically needy program eligibility has been more restricted in the most rural states compared to urban states.(8)  This affects all health domains, including obstetrics. Rising malpractice insurance rates, relatively impoverished populations, lack of facilities, and too few physicians for back-up arrangements may make obstetrical practice in rural places unattractive.(3)  Lack of local care means that many women must seek prenatal care and delivery outside of their county of residence. (3) There is some evidence that an increase in distance and travel time to prenatal care decreases the utilization of such care, leading to relatively poor outcomes.(3) Back to Top References 1. Maternal Mortality-United States 1982-1996. Morbidity and Mortality Weekly Report.September 04, 1998 / 47(34);705-7.http://www.cdc.gov/od/oc/media/fact/mmabww.htm 2. Gonzalez-Calvo J, Jackson J, Hansford C, Woodman C. Psychosocial factors and birth outcome: African American women in case management. J Health Care Poor Underserved 1998;9(4):395-419. 3. Taylor DH, Jr., Ricketts TC, 3rd. Increasing obstetrical care access to the rural poor. J Health Care Poor Underserved 1993;4(1):9-20. 4. Sanders-Phillips K, Davis S. Improving prenatal care services for low-income African American women and infants. J Health Care Poor Underserved 1998;9(1):14-29. 5. National Center for Health Statistics. Health, United States, 2004 With Chartbook on Trends in the Health of Americans.  Hyattsville, Maryland: 2004. 6. Bohn DK. Lifetime and current abuse, pregnancy risks, and outcomes among Native American women. J Health Care Poor Underserved 2002;13(2):184-98. 7. Stringer M. Personal costs associated with high-risk prenatal care attendance. J Health Care Poor Underserved 1998;9(3):222-35. 8. Carcillo JA, Diegel JE, Bartman BA, Guyer FR, Kramer SH. Improved maternal and child health care access in a rural community. J Health Care Poor Underserved 1995;6(1):23-40.    This research was supported by a National Library of Medicine (NLM) Publication Grant #5G08 LM07653-02 in support of the creation of a web site titled Factline: Tracking Health in Underserved Communities, www.factline.org. Saqi S. Maleque, MSPH, Researcher, Principal Investigator: Virginia Brennan, PhD.